Individual
NICK VANWAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
643 W 700 N STE C, LINDON, UT 84042-1366
(801) 796-0322
(801) 796-1038
Mailing address
643 W 700 N STE C, LINDON, UT 84042-1366
(801) 796-0322
(801) 796-1038
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
73978114701
UT
Other
Enumeration date
02/01/2010
Last updated
02/01/2010
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